You will have seen all my posts about London's progressively far lower death rates from Covid, but the scale of the difference is such now that it's time to bring all the information together. First, the factors that might influence a London difference.
London does have one advantage, a smaller number of the elderly but this not large enough to give the perceived advantage even from a neutral position. However London's position is far from equal in other respects since we have some huge disadvantages. These are primarily:
First in the UK to be infected with Covid from 29th January 2020 meaning level for level of infections, up to two months longer with Covid.
That very early start meant up to two months more without PPE and social distancing regulations etc than most of the UK.
By far the highest population density of any UK area, the infamous overcrowding in much of our public transport, the most overcrowded homes and some of the worst housing standards in the country, all making a mockery of social distancing.
We have by far the highest proportion of black people at 13.3%, the next nearest in the UK being the West Midlands with 3.3%. As shown by last year's research, they have four times the vulnerability to Covid of the white population. We also have very large populations of the other higher Covid risk ethnic groups having 2.5 to 1.5 times risk. Since barely over 40% of our population are White British with one times risk factor, this all adds up to a huge disadvantage.
Finally our air pollution levels which have resulted in many EU fines and threats during our membership and which are reckoned to account for a mean 3800 additional deaths per year. That's equal to 21% of our annual Covid deaths.
We might reasonably assume from these that London's Covid deaths would be much higher than the rest of the country, but in fact they are much lower, so shockingly so that explanation is demanded. In the following I haven't deducted the London population from the UK one, giving the UK a very slight advantage from the inclusion of London's lower deaths performance in the totals.
Taking the generally accepted population figure for London, (9.4 million) and the UK (67.2 millions), together with all Covid deaths, both within the 28 days measure and mentions on death certificates, London (18,011), the UK (172,657), London has 25.6% less deaths pro rata than the UK.
However, to ensure no inadvertent bias, I've recalculated using the population figures most disadvantageous to London and most advantageous to the UK. These are London down from 9.4 to 9 million, the UK up from 67.2 to 68.4 million. That reduces the London advantage from 25.6 to 20.7% less deaths pro rata, still shocking.
It means between 35,000 and 44,000 in the UK at large who have died from Covid would not have done if they'd had London's benefit. That is what is so shocking.
So what was that benefit? It certainly wasn't the vaccines, since we were first showing an advantage in late summer 2020, long before the vaccines arrived. And to emphasise that, rebellious Londoners have been vaccine resistant with much lower rates:
16.8% of the eligible have not received a first dose, 24.5% have not received a second dose and 57% have not received a booster to date, all far behind the UK vaccination rates.
So no, it clearly wasn't a vaccination advantage over the rest of the country. It was as I've long insisted, the benefit of the very early huge infection hit that we took, our immune systems creating natural immunity potentially more beneficial than the immunity conferred by any of the vaccines.
Having received so much past opposition to my views on this issue, it is naturally pleasing that there's now increasing authoritative support. The first was from Professor David Spiegelhalter, the UK's chief statistician who long after reached the same conclusion as my London one for the UK's data. Then Danidl in here reported a professor of his acquaintance reaching a conclusion exactly matching mine, that the best result comes from being infected first
before any vaccination, with the later addition of the first vaccination, then the second, progressively adding to the immunity.
Then Woosh posted the following, giving one reason for the London difference following infection:
"The Roche N assay is the interesting one. It measures the level of N-antibodies (N=nucleocapsid) post infection, the higher, the better.
It shows that London region has the highest seropositivity, South West lowest.
That explains why the death rate in London is lower than national average."
NHS region Weeks 21 - 32
East of England 13.3% (12.1% - 14.6%)
London 25.0% (23.5% - 26.6%)
Midlands 16.2% (15.0% - 17.6%)
North East and Yorkshire 15.7% (14.3% - 17.1%)
North West 20.7% (19.1% - 22.4%)
South East 12.9% (11.7% - 14.2%)
South West 9.4% (8.3% - 10.6%) . . . . . . . . . . LINK
You can see the scale of the London advantage I've highlighted in bold. However that isn't the whole story since the South West measures low but also has a London style advantage with low infection rates.
Conclusions
My first conclusion will be contentious since it has a political dimension. It is that the delay before the government acted to bring in protective measures was not a mistake in hindsight. It was an inadvertent benefit, since it increased the numbers gaining superior natural immunity from prior infection, so ultimately reducing deaths in London. Nor was it selective about who died, since we know Covid sought out the most vulnerable, no matter how early or late the infection. The only material difference was that it brought forward the deaths that did occur by the length of the delay.
My second conclusion with hindsight is that the best way to have tackled the pandemic has three elements:
1) Immediately without any delay introduce PPE and isolation advice exclusively for the most vulnerable due to age or prior health issues,
but to no others.
2) Have far better preparedness for the tiny numbers of them who do still get infected and suffer a serious Covid issue to maximise their survival.
3) The above allowing the healthy mainstream population, mostly of working age, to continue living and working as normal without protections, while gaining the low consequence infections and the resulting superior natural immunity before the vaccines arrived.
These would have resulted in a huge economic benefit, while having the potential to substantially reduce total deaths in the way London did for the the latter.
Finally and sadly, the foregoing information is of little use for those who have been vaccinated since the vaccines will in most cases have prevented them from getting sufficiently infected to gain the natural self immunity. The infection needs to be prior to any vaccines to gain that.
For everyone now though, get fully vaccinated.
N.B. All data used up to the end of 31/12/21 where possible.
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